• Reuben Ilia, Guy Amit, Carlos Cafri, Harel Gilutz, Akram Abu-Ful, Jean Marc Weinstein, Sergey Yaroslavtsev, Moche Gueron, and Doron Zahger.
• Department of Cardiology, Soroka Medical Center, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva 84101, Israel. iliar@bgumail.bgu.il
• Coron. Artery Dis. 2003 Sep 1;14(6):439-41.

BackgroundDespite early recanalization of an occluded infarct-related artery, myocardial reperfusion may remain impaired due to microvascular injury. Reperfusion arrhythmias may indicate successful microvascular reperfusion.MethodsMicrovascular reperfusion was assessed prospectively in 42 consecutive patients with ST-segment elevation acute myocardial infarction (AMI) by evaluation of the resolution of ST-segment elevation (<50% of initial level) immediately after successful coronary angioplasty. Patients were divided into two groups: those with ST resolution (n=24) and those without ST resolution (n=18). The presence of reperfusion arrhythmias immediately after recanalization was recorded.ResultsPatients with ST resolution were younger (54+/-12 years compared with 64+/-17 years, P=0.04), their pain-to-recanalization time was shorter (195+/-87 min compared with 294+/-179 min, P=0.05), they were less often diabetic (13% compared with 24%, P=0.05) and were more often given IIb/IIIa inhibitors (58% compared with 22%, P=0.02). Reperfusion arrhythmias were observed in 15 out of 24 patients with ST resolution (62%) but in only one out of 18 without ST resolution (5%) (P<0.01). Reperfusion arrhythmias included accelerated idioventricular rhythm, 13 (81%); multifocal ventricular premature beats, two (13%); and ventricular tachycardia, one (6%). The sensitivity and specificity of reperfusion arrhythmias for ST resolution were 62 and 95%, respectively. In a logistic regression model including age, time to treatment, diabetes, use of IIb/IIIa inhibitors and reperfusion arrhythmias, only the latter was found to be an independent predictor of ST resolution (P<0.01).ConclusionReperfusion arrhythmias following coronary angioplasty for AMI are a highly specific marker for ST resolution and may indicate successful microvascular reperfusion.

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